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    Washington's political failures and your practice


    To say I am frustrated by the failure of the Joint Select Committee on Deficit Reduction (aka the "super committee") to reach a sensible plan to reduce the federal government's crushing debt burden is an understatement. Ostensibly fueled by conservative intransigence over tax increases and liberal immobility over entitlement reform, it seems that the net effect is continued governmental paralysis amid the greatest intergenerational wealth transfer in history.

    In his new book, Boomerang: Travels in the New Third World, Michael Lewis details how a similar lack of political will, fiduciary responsibility, and simple common sense is eroding Europe's future economic stability as well.1 In this fascinating little book, Lewis also points out that in addition to ballooning federal governmental deficits, US state and local governments face a $500 billion collective annual deficit and a $1.5 trillion gap between what they owe retired workers and the funds they have on hand to pay them. He ascribes both America's addiction to debt and our accelerating obesity epidemic to our primitive midbrain "reptilian core" that, after millennia of periodic famines, wars, and other external threats, prompts us to "acquire as much as we can of things we perceive as scarce."

    While one is free to ascribe the super committee's abject failure to an inherent collective neurophysiologic dysfunction, a more prosaic explanation is that it is just another symptom of the increasing polarization of the American polity. However, I would like to offer a third, less charitable and far more cynical interpretation. The super committee's failure will, after all, automatically trigger $1.2 trillion in cuts, equally divided between social programs and defense spending, over the next 10 years.2 Moreover, these reductions in government spending will likely be coupled with $3.9 trillion in added tax revenue accruing expiration of the Bush-era tax cuts, assuming our current governmental gridlock conveniently continues.3 Thus, through simple inaction Congress would have reduced by a significant portion the $8.4 trillion in additional debt the US government would have otherwise accumulated by 2021.4 The best part for them is that politicians facing an angry electorate can deny, with some justification, that they were personally responsible for either cuts in social services or increases in taxes. But this is a cynical interpretation. Perhaps it is best to blame our lizard-derived hypothalami.

    Implications to healthcare

    So what are the implications of Congress' extraordinary feat of budgetary legerdemain for US healthcare? The immediate impacts of the pending across-the-board cuts include:

    • a 2% cut to Medicare amounting to $123 billion over 8 years.2 These cuts will fall on physicians and hospitals and could reduce their availability to care for elderly patients. This assumes Congress will come to its senses and not enact the scheduled 27% SGR-mandated physician payment reduction5 scheduled for January 1, which, in my opinion, would effectively end the program. In any case, this Medicare cut will be exacerbated by Medicaid cuts to providers being implemented by virtually every state.
    • a $ 600 million reduction in the Special Supplemental Nutrition Program for Women, Infants, and Children at a time when poverty affects more and more Americans.6
    • a 2%, or about $2.5 billion, cut in the National Institutes of Health budget in 2013, which will exacerbate the stagnant funding that has occurred since 2006.7
    • a potential 2% cut in graduate medical education (GME) layered onto the GME cap put into effect in 1997. This could reduce available residency slots just as there has been a sizeable increase in medical student admissions over the past 5 years.8 Thus, US medical school graduates may find it more difficult to obtain residency slots, exacerbating the pending physician shortage.


    Charles J. Lockwood, MD, MHCM
    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...


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